Pregnancy, childbirth and strenuous exercise can all place tremendous strain on a woman’s body, particularly the pelvic floor. This can result in pelvic floor prolapse, or POP, a painful, sometimes embarrassing condition. Find out what causes it and what you can do...

Over the years, physical stresses can weaken the natural support structure of the pelvis, causing the pelvic organs to shift or become herniated from their natural position. In fact, according to the National Institutes of Health, nearly one in four women in the U.S. suffer from some form of pelvic floor disorder. One of the most common is pelvic organ prolapse or POP.

With POP, pelvic tissues are unable to support the uterus, rectum, bowel, urethra and/or bladder. Consequently, those organs slide, bulge or push against each other or protrude outside of the vagina – also known as prolapse.

A prolapse can cause discomfort, especially after walking or standing for certain periods of time. Other side effects can include: urinary problems, such as urgency and frequency to void; retention of urine; urinary incontinence (leakage); difficulty with bowel function; infections; and lower back pain or pelvic pain.

Even though POP is treatable, many women suffer in silence due to embarrassment, anxiety or the mistaken belief that prolapse is a normal part of aging. But POP isn’t a fact of life: It’s a treatable condition that shouldn't impact one’s quality of life.

What Causes POP?Childbirth, aging, physical labor and menopause can all contribute to POP. Additionally, health issues such as tobacco abuse, chronic coughing, autoimmune disorders, pelvic surgeries (like a hysterectomy) and obesity raise a woman’s risk of developing the condition. Women who have had a vaginal birth are at a greater risk for POP than women who have delivered via Cesarean section.

Some less common disorders, such as spinal cord injuries, muscular dystrophy and multiple sclerosis, may also raise the risk of POP. These diseases cause the pelvic muscles to weaken due to inactivity or restricted movement.

Genetic predisposition may also be a factor, although it’s rare. This includes genetic collagen deficiencies, where the absence of a natural protein prevents tissues from remaining elastic.

What Are the Symptoms? Many women will not notice any symptoms of prolapse. Others may experience lower backache or sensations of pulling and stretching in the pelvis and groin area in the early stages of the condition.

Once prolapse is more advanced, the most common symptom is the bulging of a prolapsed organ into the vagina. It may not be sore, but it is uncomfortable – there may be a feeling of pressure, as though the vagina were falling out.

Some women feel the frequent or urgent need to urinate or experience constipation, pain or straining during bowel movements. Vaginal spotting or bleeding may occur, and sex can become painful.

In severe prolapse, the pelvic organs can actually bulge outside of the vagina. The exposed tissue can become irritated, raw and infected. Severe prolapse may also cause urinary incontinence.

How Can POP Be Treated? Depending on the degree of the prolapsed, treatment can vary. Doctors will also factor in a woman’s age (younger patients tend to be more active and put additional strain on their pelvic floor support), her plans for bearing children, and whether she has previously had prolapse repair.

Prolapse most commonly affects older women who have had children. If their condition is severe, pelvic reconstructive surgery is the best treatment option.

Although pelvic floor reconstruction doesn’t impact the patient’s ability to get pregnant, younger women planning to have children may want to delay surgery because childbirth will sometimes cause the prolapse to recur. For these women, nonsurgical treatments such as Kegel exercises or pessaries may be better options.

Kegel exercises: These strengthen the pelvic floor, which can help support the organs in the pelvic region and relieve pressure from prolapse. Squeeze your pelvic muscles as if you were trying to stop the flow of urine. Hold the contraction and count to 10, then relax and repeat. Aim for three sets of 10 each day, or as often as possible.

Pessaries: A pessary is a small device, similar to a diaphragm, that is inserted into the vagina to support the prolapse organs. Pessaries come in many shapes and sizes − your doctor will fit you with the correct size and shape, as well as instruct you how to remove, clean and reinsert it.

Estrogen or hormonal replacement therapies are also sometimes prescribed. But as with other nonsurgical treatments, they won’t cure or reverse prolapse, but may reduce symptoms.

Surgical Treatments for POPSurgical prolapse repair is designed to reposition and secure the pelvic organs.

There are minimally invasive operations that can be performed through the vagina. The procedure can take 30 minutes to two hours, depending on the severity of prolapse and number of prolapsed sites. Patients may be hospitalized for the procedure, typically for a single overnight stay.

These procedures usually correct prolapsed successfully and are becoming more common: Each year, approximately 200,000 prolapse surgeries are performed.

Historically, pelvic floor procedures have used plastic or synthetic repairs. However, the human body often does not respond well to synthetic, non-natural devices, which may cause foreign body reactions.

In some cases, the synthetic mesh fails to secure the prolapsed organs, or causes an inflammation or erosion of surrounding tissues. The mesh can also become exposed in the vagina – it’s the body’s reaction to the synthetic product. The FDA has received approximately 1,000 reports to date of such complications, linked specifically to the use of synthetic material in prolapse repair.

These days, surgeons may recommend a natural biologic material that communicates with the body, signalling the patient’s surrounding tissue to remodel and repair itself. When the biologic material is placed on a wound or broken tissue, the human body uses it as a scaffold or guide for the patient’s own tissue to repair itself.

When the graft is placed within the pelvic floor, cells gradually begin to enter and use the graft to form new tissues, attracting cells and nutrients to the area. Over time, the scaffold is replaced by the patient’s own tissue.

Once the healing process is complete, the biologic graft is undetectable. The body’s own defense mechanisms then takes over in reaching and responding to infection.

Preventing Pelvic Organ ProlapseThere are several steps women can take to keep their pelvic floor muscles strong and their pelvic organs in position:

Eat high-fiber foods to prevent constipation and reduce straining.

Cut down on caffeine. A diuretic, it causes frequent or urgent urination and subsequent straining to empty the bladder.

Maintain a healthy weight.

Do pelvic-floor (Kegel) exercises every day to tighten and strengthen pelvic muscles.